Washington ? Some 300,000 Americans with failed kidneys stay alive by getting their blood cleaned three times a week at dialysis centers. But a new report says too many of those facilities provide inadequate treatment.

Government officials hope quality will improve in January when new Medicare payment rules give physicians financial incentives to examine dialysis patients more frequently. The change means a pay raise for kidney specialists who see dialysis patients at least four times a month, and a pay cut for those that have less frequent exams, now believed to be the norm.

That’s only one of a series of quality of care questions surrounding dialysis, where inspections are few and far between. Medicare’s chief says while he longs to send more inspectors to the nation’s 4,000 dialysis centers, doing so will require more money from Congress.

“If there’s one particular area (where) we need to do more, it’s kidney dialysis,” says Tom Scully, administrator of the Center for Medicare and Medicaid Services. “But it’s hard to get attention to it.”

Kidney disease is rising at an alarming rate, and the number of people requiring dialysis or a transplant to stay alive is expected to double in the next decade. Medicare, the health insurance program for the elderly, pays for dialysis for Americans of any age, with costs already totaling $16 billion a year.

Overall, dialysis care has gotten much better over the last two decades, says Dr. Brian Pereira of the National Kidney Foundation. And the dialysis industry notes that problem facilities are a minority.

But a recent report by congressional investigators says there isn’t enough federal oversight to force needed improvements at a significant number of dialysis centers. The General Accounting Office found:

• At 512 facilities in 2000, blood tests show a fifth of patients received inadequate dialysis treatment. Pereira cautions that some undoubtedly were new patients not yet receiving the full benefit of the dialysis. But others either weren’t prescribed enough dialysis or weren’t on the machines long enough at each visit to do the job.
• At 1,700 dialysis facilities, 20 percent or more patients received inadequate drug treatment for anemia — a deficiency in red blood cells that is common with kidney failure.
• A growing number of centers — 216 at last count — have gone nine or more years without an inspection of whether they comply with quality standards.

“The oversight and enforcement of this industry is stuck in the Stone Age,” says Sen. Charles Grassley, R-Iowa, who three years ago urged improvements that didn’t happen.

Other problems likely are going unreported because patients fear centers will quit treating those who complain, Grassley wrote to Medicare in a demand for change.

“We have no choice, we have to live with these people,” says Amy Staples, 45, of Laredo, Mo. “If we stopped the treatment at any point, we would die.”